Showing papers by "Bradley Hospital published in 2015"

Increased Sensitivity of the Circadian System to Light in Early/Mid-Puberty

Abstract: Context: Late adolescence is marked by a delay in sleep timing, which is partly driven by a delay shift of the circadian timing system. This study examined whether the sensitivity of the circadian system to light—the primary entraining stimulus to the circadian system—differs between pre- to mid-pubertal and late to postpubertal adolescents. Objective: The study was designed to determine the influence of puberty on the sensitivity of the circadian system to light in humans. Methods: Melatonin suppression to low and moderate light levels was assessed in 38 pre- to mid-pubertal (9.1–14.7 years) and 29 late to postpubertal (11.5–15.9 years) adolescents. They received 1 hour of four light levels on consecutive nights: approximately 0.1 (near-dark baseline condition), 15, 150, and 500 lux. One group received evening light beginning at 11:00 pm (n = 39); a second group received morning light beginning at 3:00 am (n = 28). Salivary melatonin was sampled every 30 minutes. Melatonin suppression for 15, 150, and 50...

Female Autism Phenotypes Investigated at Different Levels of Language and Developmental Abilities.

Abstract: This study investigated the differences in clinical symptoms between females and males with autism spectrum disorder (ASD) across three verbal ability groups (nonverbal, phrase and fluent speech), based on which Autism Diagnostic Observation Schedule module was administered to 5723 individuals in four research datasets. In the Simons Simplex Collection and Autism Treatment Network, females with ASD and phrase or fluent speech had lower cognitive, adaptive, and social abilities than males. In the Autism Genetics Resource Exchange and the Autism Consortium, females with phrase or fluent speech had similar or better adaptive and social abilities than males. Females who were nonverbal had similar cognitive, adaptive, and social abilities as males. Population-based longitudinal studies of verbally fluent females with ASD are needed.

Methylation of exons 1D, 1F, and 1H of the glucocorticoid receptor gene promoter and exposure to adversity in preschool-aged children.

Abstract: Epigenetic modifications to the genome are a key mechanism involved in the biological encoding of experience. Animal studies and a growing body of literature in humans have shown that early adversity is linked to methylation of the gene for the glucocorticoid receptor (GR), which is a key regulator of the hypothalamic-pituitary-adrenal axis as well as a broad range of physiological systems including metabolic and immune function. One hundred eighty-four families participated, including n = 74 with child welfare documentation of moderate-severe maltreatment in the past 6 months. Children ranged in age from 3 to 5 years, and were racially and ethnically diverse. Structured record review and interviews in the home were used to assess a history of maltreatment, other traumas, and contextual life stressors, and a composite variable assessed the number exposures to these adversities. Methylation of regions 1(D), 1(F), and 1(H) of the GR gene was measured via sodium bisulfite pyrosequencing. The composite measure of adversity was positively correlated with methylation at exons 1(D) and 1(F) in the promoter of the GR gene. Individual stress measures were significantly associated with a several CpG sites in these regions. GR gene methylation may be a mechanism of the biobehavioral effects of adverse exposures in young children.

Self-injurious implicit attitudes among adolescent suicide attempters versus those engaged in nonsuicidal self-injury.

Abstract: BACKGROUND: Suicide is among the most important mental health issues affecting adolescents today despite much research on its detection and prevention. Beyond suicide attempts (SAs), clinicians are increasingly confronted with another, potentially related problem: non-suicidal self-injury (NSSI)-defined as the deliberate destruction of body tissue without intent to die. NSSI may increase risk for making an SA by sevenfold, but many studies examining this link have involved youths engaging in both NSSI and SAs. Thus, there is a need to compare homogeneous groups of adolescents engaged in NSSI-only or SA-only, but not both, to advance what is known about each form of self-harm. The self-injurious implicit association task (SI-IAT) is a particularly important computerized behavioral task to study such adolescents because the SI-IAT provides objective behavioral data about problems for which people may lack insight or be motivated to conceal, such as SAs and NSSI. METHODS: We evaluated implicit associations with cutting and death/suicide using the computerized SI-IAT in three mutually exclusive groups: (1) adolescents who made an SA but had never engaged in NSSI (n = 47); (2) adolescents who engaged in NSSI but had never made an SA (n = 46); and (3) typically developing control (TDC) adolescents without history of psychiatric problems (n = 43). RESULTS: Nonsuicidal self-injury participants had stronger identification with cutting versus no cutting than either SA or TDC participants. Contrary to our hypothesis, NSSI participants had stronger identification with suicide/death versus life than either SA or TDC participants. CONCLUSIONS: Strong implicit attitudes towards suicide/death among adolescents with NSSI without a prior SA suggest that clinicians should not dismiss NSSI as not serious. Further work is required to elucidate the mechanism by which youths engaged in NSSI acquire these stronger identifications and make a first-time SA to develop novel treatment and prevention strategies blocking this transformation, ultimately reducing youth suicide. Language: en

Estimating sleep from multisensory armband measurements: validity and reliability in teens.

Abstract: Given the recognition that sleep may influence obesity risk, there is increasing interest in measuring sleep parameters within obesity studies. The goal of the current analyses was to determine whether the SenseWear(®) Pro3 Armband (armband), typically used to assess physical activity, is reliable at assessing sleep parameters. The armband was compared with the AMI Motionlogger(®) (actigraph), a validated activity monitor for sleep assessment, and with polysomnography, the gold standard for assessing sleep. Participants were 20 adolescents (mean age = 15.5 years) with a mean body mass index percentile of 63.7. All participants wore the armband and actigraph on their non-dominant arm while in-lab during a nocturnal polysomnographic recording (600 min). Epoch-by-epoch sleep/wake data and concordance of sleep parameters were examined. No significant sleep parameter differences were found between the armband and polysomnography; the actigraph tended to overestimate sleep and underestimate wake compared with polysomnography. Both devices showed high sleep sensitivity, but lower wake detection rates. Bland-Altman plots showed large individual differences in armband sleep parameter concordance rates. The armband did well estimating sleep overall, with group results more similar to polysomnography than the actigraph; however, the armband was less accurate at an individual level than the actigraph.

Borderline personality disorder in transition age youth with bipolar disorder.

Abstract: Objective To determine the longitudinal impact of borderline personality disorder (BPD) on the course and outcome of bipolar disorder (BP) in a pediatric BP sample. Method Participants (N = 271) and parents from the Course and Outcome of Bipolar Youth (COBY) study were administered structured clinical interviews and self-reports on average every 8.7 months over a mean of 93 months starting at age 13.0 ± 3.1 years. The structured interview for DSM-IV personality disorders (SIDP-IV) was administered at the first follow-up after age 18 to assess for symptoms of BPD. BPD operationalized at the disorder, factor, and symptom level, was examined as a predictor of poor clinical course of BP using all years of follow-up data. Results The number of BPD symptoms was significantly associated with poor clinical course of BP, above and beyond BP characteristics. Affective dysregulation was most strongly associated with poor course at the factor level; the individual symptoms most strongly associated with poor course were dissociation/stress-related paranoid ideation, impulsivity, and affective instability. Conclusion BPD severity adds significantly to the burden of BP illness and is significantly associated with a more chronic and severe course and outcome beyond what can be attributable to BP characteristics.

Facial emotion recognition in childhood‐onset bipolar I disorder: an evaluation of developmental differences between youths and adults

Abstract: Objectives Bipolar disorder (BD) is a severe mental illness with high healthcare costs and poor outcomes. Increasing numbers of youths are diagnosed with BD, and many adults with BD report that their symptoms started in childhood, suggesting that BD can be a developmental disorder. Studies advancing our understanding of BD have shown alterations in facial emotion recognition both in children and adults with BD compared to healthy comparison (HC) participants, but none have evaluated the development of these deficits. To address this, we examined the effect of age on facial emotion recognition in a sample that included children and adults with confirmed childhood-onset type-I BD, with the adults having been diagnosed and followed since childhood by the Course and Outcome in Bipolar Youth study. Methods Using the Diagnostic Analysis of Non-Verbal Accuracy, we compared facial emotion recognition errors among participants with BD (n = 66; ages 7–26 years) and HC participants (n = 87; ages 7–25 years). Complementary analyses investigated errors for child and adult faces. Results A significant diagnosis-by-age interaction indicated that younger BD participants performed worse than expected relative to HC participants their own age. The deficits occurred both for child and adult faces and were particularly strong for angry child faces, which were most often mistaken as sad. Our results were not influenced by medications, comorbidities/substance use, or mood state/global functioning. Conclusions Younger individuals with BD are worse than their peers at this important social skill. This deficit may be an important developmentally salient treatment target – that is, for cognitive remediation to improve BD youths’ emotion recognition abilities.

Psychiatric Hospitalization of Children With Autism or Intellectual Disability: Consensus Statements on Best Practices

Abstract: Psychiatric hospitalization of children with Autism Spectrum Disorder (ASD) and/or Intellectual Disability (ID), is both common and challenging. Children with ASD are six times more likely to be psychiatrically hospitalized than children without ASD.1 Due to the limited number of specialized psychiatric units for children and adolescents with ASD or ID in the United States, most admissions are to general child and adolescent psychiatric units. Staff may have limited experience with this population, and the treatment approach and therapeutic milieu may not be well adapted to children with ASD or ID. General units typically use verbal interventions (e.g., individual, family and group therapies), programming with high social demands, and general reinforcements (e.g., level systems). These interventions can be less effective in children with ASD or ID, who have impairments in social communication and cognitive abilities and may have rigid routines and preferences. Specialized units have shown improvement in the behavioral functioning of children with ASD or ID two months after discharge2, as well as decreased readmissions,3 in two uncontrolled studies with an average length of stay of 26–42 days. To identify best practices for psychiatric inpatient care of children with ASD or ID a panel of expert clinicians (child and adolescent psychiatrists, psychologists and pediatricians) from six United States specialized units convened. Due to the limited amount of research in this area, evidence-based recommendations were not feasible, and the panel undertook a consensus process based on existing literature and expert opinion gathered from a survey, a semi-structured telephone interview with the participants and regular conference calls. Although inpatient facilities can have significant resource constraints, the following consensus statements encompass trends in practices currently utilized by specialized units, and offer a vision of how to best serve this population. As such, the panel sought to strike a balance between identifying best practices and providing recommendations that may be attainable on general units.

Genetic variation in the oxytocin receptor gene is associated with a social phenotype in autism spectrum disorders.

Abstract: Oxytocin regulates social behavior in animal models. Research supports an association between genetic variation in the oxytocin receptor gene (OXTR) and autism spectrum disorders (ASD). In this study, we examine the association between the OXTR gene and a specific social phenotype within ASD. This genotype-phenotype investigation may provide insight into how OXTR conveys risk for social impairment. The current study investigated 10 SNPS in the OXTR gene that have been previously shown to be associated with ASD. We examine the association of these SNPs with both a social phenotype and a repetitive behavior phenotype comprised of behaviors commonly impaired in ASD in the Simons simplex collection (SSC). Using a large sample to examine the association between OXTR and ASD (n = range: 485-1002), we find evidence to support a relation between two OXTR SNPs and the examined social phenotype among children diagnosed with ASD. Greater impairment on the social responsiveness scale standardized total score and on several subdomains was observed among individuals with one or more copies of the minor frequency allele in both rs7632287 and rs237884. Linkage disequilibrium (LD) mapping suggests that these two SNPs are in LD within and overlapping the 3' untranslated region (3'-UTR) of the OXTR gene. These two SNPs were also associated with greater impairment on the repetitive behavior scale. Results of this study indicate that social impairment and repetitive behaviors in ASD are associated with genomic variation in the 3'UTR of the OXTR gene. These variants may be linked to an allele that alters stability of the mRNA message although further work is necessary to test this hypothesis.

Emotion Understanding (and Misunderstanding) in Clinically Referred Preschoolers: The Role of Child Language and Maternal Depressive Symptoms

Abstract: There is growing evidence to suggest that children with mental health problems have difficulties in emotion understanding, including particular biases in their processing of emotion information. However, less is known about the specific developmental and socialization processes that may contribute to difficulties in emotion understanding in young children with emotional and behavioral problems. The present study examines the roles of child receptive language and maternal depressive symptoms in predicting emotion understanding in clinically referred preschoolers. Participants were 79 preschool-aged children (3–5 years of age) who were admitted to a psychiatric day treatment program for young children and their families. Children participated in assessments of receptive language skills and emotion understanding and mothers completed self-report measures of depressive symptoms and child behavior problems. Children’s receptive language skills were positively associated with accuracy in identifying happy, sad, angry, and scared emotions, whereas maternal depressive symptoms were specifically linked to children’s biased perceptions of sadness. Findings underscore the role of both child and family factors as related to individual differences in emotion understanding in clinically referred preschoolers, with implications for developmentally informed and emotion-focused approaches to treatment of early childhood psychopathology.

Sleepiness and Cognitive Performance among Younger and Older Adolescents across a 28-Hour Forced Desynchrony Protocol.

Abstract: STUDY OBJECTIVES: Quantify the homeostatic and circadian effects on sleepiness and performance of adolescents. Examine age-related changes in homeostatic and circadian regulation of sleepiness and performance by comparing younger and older adolescent groups. DESIGN: Three-week laboratory study including 12 cycles of a 28-h forced desynchrony protocol. SETTING: Controlled laboratory environment with individual sleep and performance testing rooms and shared common areas. PARTICIPANTS: Twenty-seven healthy adolescents including 16 females. Ages ranged from 9.6-15.2 years and participants were split into younger (n = 14 ages 9-12) and older (n = 13 ages 13-15) groups based on median age split of 13.0 years. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Testing occurred every 2 h during scheduled wake periods. Measures included sleep latency during repeated nap opportunities and scores from a computerized neurobehavioral assessment battery including a 10-min psychomotor vigilance task, a digit symbol substitution task, and the Karolinska Sleepiness Scale. Significant main effects of circadian and homeostatic factors were observed, as well as several circadian and homeostatic interaction effects. Age group did not have a significant main effect on sleep and performance data. A significant interaction of circadian phase and age group was found for sleep latency, with younger adolescents showing greater circadian modulation than older teens during the circadian night. CONCLUSIONS: Adolescents demonstrated a similar pattern of response to forced desynchrony as reported for adults. Sleepiness and performance were affected by homeostatic and circadian factors, and age group did not interact with homoeostatic and circadian factors for subjective sleepiness and most performance metrics. Younger adolescents had a shorter latency to sleep onset than older during the circadian bin spanning 4 to 8 h after the onset of melatonin secretion. Language: en

Longitudinal associations between interpersonal relationship functioning and mood episode severity in youth with bipolar disorder.

Abstract: This study examined the longitudinal association between mood episode severity and relationships in youth with bipolar (BP) disorder. Participants were 413 Course and Outcome of Bipolar Youth study youth, aged 12.6 ± 3.3 years. Monthly ratings of relationships (parents, siblings, and friends) and mood episode severity were assessed by the Adolescent Longitudinal Interval Follow-up Evaluation Psychosocial Functioning Schedule and Psychiatric Rating Scales, on average, every 8.2 months over 5.1 years. Correlations examined whether participants with increased episode severity also reported poorer relationships and whether fluctuations in episode severity predicted fluctuations in relationships, and vice versa. Results indicated that participants with greater mood episode severity also had worse relationships. Longitudinally, participants had largely stable relationships. To the extent that there were associations, changes in parental relationships may precede changes in episode severity, although the magnitude of this finding was small. Findings have implications for relationship interventions in BP youth.

Adverse Events in Very Young Children Prescribed Psychotropic Medications: Preliminary Findings from an Acute Clinical Sample.

Abstract: Objective: The present study used the Pediatric Adverse Events Rating Scale (PAERS) to provide a systematic assessment of adverse events (AEs) related to psychotropic medication use in a clinical sample of young children attending a specialized, early childhood partial hospital program. Study goals were as follows: 1) To describe the frequency and types of specific psychotropic medication-related AEs experienced by very young children (ages 3–7 years) in an acute clinical sample, and 2) to identify the psychotropic medication(s) and/or class(es) associated with the highest frequency of AEs. Methods: Participants were 158 children (118 males; ages 36–95 months, mean=66 months, SD=14.6 months) who presented to a hospital-based day treatment program for young children with severe emotional and behavioral problems, and were prescribed a psychotropic medication at any point during the hospitalization. Data on AEs related to psychotropic medication were collected using the PAERS from 2011 to 2014. Resu...

Sleep Onset and Night Waking Insomnias in Preschoolers with Psychiatric Disorders

Abstract: This study examined the nature and prevalence of diagnostically defined sleep disorders, including Sleep Onset Insomnia (SOI) and Night Waking Insomnia (NWI), in a sample of 183 young children admitted to an early childhood psychiatric day treatment program. A semi-structured diagnostic interview, the Diagnostic Infant and Preschool Assessment, was used to assess for sleep and other psychiatric disorders. Daily sleep diaries and the Child Behavior Checklist were also examined. 41 % of children met criteria for a sleep disorder; 23 % met diagnostic criteria for SOI and 4 % met criteria for NWI, with an additional 14 % meeting criteria for both (SOI + NWI). Sleep-disordered children demonstrated longer latency to sleep onset, longer and more frequent night awakenings, less total sleep, and lower sleep efficiency than non-sleep disordered participants. Diagnosable sleep disorders, particularly SOI, were quite common in this acute clinical sample, exceeding previous estimates obtained in community and pediatric practice samples.

The Path to Somewhere: Moving Toward a Better Biological Understanding of Irritability.

Abstract: In childmental health, irritability is everywhere and nowhere at once. Irritability is the most common reason children are brought for psychiatric evaluation (.40% of emergency department cases; .20% of outpatients [1–3]). Irritability is an explicit diagnostic criterion or associated symptom for multiple DSM diagnoses affecting children and adults, including mania in bipolar disorder, generalized anxiety disorder, attention deficit hyperactivity disorder (ADHD), oppositional defiantdisorder, autismspectrumdisorder (ASD), and thenew DSM-5disruptivemooddysregulationdisorder (DMDD), plus child-specific modifications to the major depressive episode criteria. Irritability is linked to significant impairment in adulthood, including academic problems, poverty, psychopathology, and suicidality (4–6). Yet there is no reliable marker, measure, or test to help clinicians determine which diagnosis (or diagnoses) involving irritability an individual patient has or which treatment for irritability would work best. Indeed, the lack of such biomarkers is one factor contributing to the overdiagnosis or misdiagnosisof theseconditions.Forexample,upto20%ofchildren discharged from psychiatric hospitalization are diagnosed with bipolar disorder (7); rates of children with ASD increased 78% from 2002 to 2008, accounting for 1 of every 88 children (8); and 28% more children were medicated for ADHD in 2011 than in 2007 (9). There is a clear need to get somewhere along the path toward a greater biological understanding of irritability across the lifespan. The study reported by Roberson-Nay et al. in this issue of the Journal (10) is an important step on that path. This study examined the temporal pattern of genetic and environmental effects of irritability. To achieve this goal, the investigators harnesseddata from the SwedishTwinStudy ofChildren and AdolescentDevelopment,whichassessed twins in fourwaves between ages 8 and 20 (wave 1, ages 8–9; wave 2, ages 13–14; wave 3, ages 16–17; and wave 4, ages 19–20). Altogether, 1,310 twin pairs participated, including 267 female/female monozygotic, 199 female/female dizygotic, 254 male/male monozygotic, 182male/maledizygotic, and408opposite-sexdizygotic twin pairs. Irritability was assessed using the parent-completed Child Behavior Checklist and the twin-completed Youth SelfReport (at waves 2 and 3) and the Adult Behavior Checklist (at wave 4). The study demonstrated that the genetic effects on irritability are strong, are developmentally dynamic frommiddle childhood through young adulthood, and are associated with distinct patterns in males and females. In males, genetic influences on irritability increased with age, while nonshared environmental influences weakened. In contrast, in females, genetic influences on irritabilitywere initially strong, and then declined with age, while nonshared environmental influences were stable throughout development. Notably, shared environmentwasnotaprimary influenceonirritability formalesor females, accounting for only 1%25% of the variability. This study is significant because it moves us closer toward the goal of identifying biobehavioral markers of irritability. From a psychopathology perspective, it suggests biologically determined trajectories of irritability that could improve our classification and diagnosis of irritability. From a treatment perspective, it suggests developmentally salient periods that might be ripe for targeted treatments. The study also serves as a response to a call, made during a 2014 conference sponsoredby theNational Institute of Mental Health (NIMH), for more research on the biological underpinnings of irritability. How do we get to a point where such biobehavioral markers augment clinicians’work with actual patients? Yogi Berra provided important guidance for this journey: “You’ve got to be very careful if you don’t knowwhere you’re going, because you might not get there.” It would be both easy and unfortunate if we gave up on this journey because researching irritability, particularly in children, is complicated. The greatest issue is the lack of a well-accepted definition of irritability. While most clinicians know irritability when they see it (to paraphrase Justice Potter Stewart), we lack consensus about what irritability is and how to differentiate pathological irritability from typical development, or irritability in one disorder from in another. Thanks to work testing potential definitions during the past decade, we are further along the path. Among these efforts include thework of EllenLeibenluft,M.D. (a coauthor on the Roberson-Nay et al.) in relation to children with primary mood disorders. Dr. Leibenluft employed a neuroscience definition of irritability as “markedly increased reactivity This study is significant because it moves us closer toward the goal of identifying biobehavioral markers of irritability.